A Comparison of Laparoscopic Pancreaticoduodenectomy and Open Pancreaticoduodenectomy at different stages of Learning curves：A single center report

Abstract

Abstract Background: With the advancement of surgical instruments and the growth of professional expertise over the last decade,laparoscopic pancreaticoduodenectomy(LPD) was widely applied in different centers.However, there are still some controversies about the safety of LPD.Hospital size, solid professional working experience,and the learning curve all have an impact on perioperative outcomes.In this study,our aim is to compare the outcomes at different stages of learning curve for LPD with open pancreatoduodenectomy(OPD). Methods: We retrospectively analyzed the clinical datas of 911 patients who received PD at a single institution.Among them,208 patients underwent OPD and 703 cases were performed LPD successfully. According to the key point of the learning curve for LPD,we divided those patients into three phases,and compared the perioperative outcomes with OPD at different phases. Result: In the initial stage,the incidence of complications and mortality related with LPD were significantly higher than those in OPD group,and the number of harvested lymph nodes,R0 resection rate were were similar with OPD group. Postoperative complications, operative time and intraoperative blood loss were significantly reduced with improved surgical experience. At the mature stage of learning curve, the incidence of postoperative complications in LPD was lower than in OPD group.Simultaneously, the length of hospital stay was substantially reduced and statistical considerably shorter than in the OPD group. Conclusion: After a long period of training and learning, LPD can be performed safely.Meanwhile,after the surgeons have surmounted the learning curve,compared with OPD, LPD can achieve similar oncology results,lower the incidence of postoperative complications as well as faster the postoperative recovery.